THE ROLE OF PREOPERATIVE PLANNING IN INCREASING IN THE TREATMENT EFFICIENCY OF HUMERUS SHAFT FRACTURES

Abstract

Fractures of the humeral diaphysis often cause problems traumatologists encounter in their daily practice. With the development of industrialized society, the nature of injury in patients of working age has changed: low-energy injury is replaced by high-energy one. To ensure the treatment efficiency to patients with humeral fractures, thorough preoperative planning is mandatory. It often includes additional imaging methods as Xray and computed tomography. The purpose of this study is to determine the role of preoperative planning in improving the efficiency of the treatment of humeral shaft fractures. Materials and methods. The study involved 49 patients aged from 19 to 75 years with comminuted fractures of the humeral shaft. By the age distribution, patients of working age prevailed, by the sex distribution, men dominated. In most of the cases (81.6%), there were high-energy traumas. According to the AO classification, 20.4% of fractures were assessed as type 12B, 79.6% of the traumas belonged to the type 12C. 18.4% of the patients received conservative treatment, 81.6% of the patients underwent surgical treatment. In 42.9% of cases, CT with threedimensional reconstruction was performed to provide precise anatomical information of the humeral fractures. In 61.2% of cases, in order to develop optimal tactical repositions of bone fragments, we used a scheme of typical contact relationships between bone and various tissue of the studied area of the humerus.
 Results and discussion. All patients were divided into 4 groups depending on the examination methods applied and the chosen tactics of preoperative planning. The first group consisted of the patients who, for preoperative planning purposes, were performed on only standard radiographic in two projections. The second group included patients who received CT with anatomical 3D models in combination with standard radiographs. The third group consisted of patients who underwent standard radiography in combination with the schemes of typical contact relationships between bone and possible tissue. The patients in the fourth group received radiographs, computed tomography with anatomical 3D models, and an applied scheme of typical contact relationships for preoperative planning. Additional research methods, namely some anatomical 3D modelling based on the CT findings, in combination with biomechanical features of changes in bone fragments contribute to the improvement in the quality of preoperative planning, the development of the algorithm of anatomical and functional intraoperative reposition, as well as reduce the risk of iatrogenic damage to important soft tissue structures.